Provider Demographics
NPI:1841610730
Name:STEVENSON, LINDA (MA CCC-SLP)
Entity type:Individual
Prefix:
First Name:LINDA
Middle Name:
Last Name:STEVENSON
Suffix:
Gender:F
Credentials:MA CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2830 E BROWN RD STE 1
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85213-5431
Mailing Address - Country:US
Mailing Address - Phone:602-910-1409
Mailing Address - Fax:
Practice Address - Street 1:2830 E BROWN RD STE 1
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85213-5431
Practice Address - Country:US
Practice Address - Phone:602-910-1409
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-04-18
Last Update Date:2019-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZSLP 8045235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist